Objective To compare the effect between computer assisted navigation total knee replacement and conventional total knee replacement on rotation alignment,mechanical axes,comPOnent position and clinical outcomes.Methods Eighty-two patients were recruited into this pmspoctive study according to entry criteria and were randomly selected into either control group which treated with standard knee replacements or navigation assisted group which operated with navigation assisted total knee replacements.To analyze the rotation of the femoral component and the tibial component in the transverse plane.the combined rotation of both components and mismatch between two components,the mechanical axes,which were measured from postoperative radiographs and computed tomography images.To compare the functional outcomes at 6 weeks and 6 months.Results There were significant diffefences(P＜0.05)in following parameters between control group and navigation assisted group:average rotation of femoral component were 1.51°±3.55°in control group and-0.63°±3.04°in navigation assisted group,the combined rotation of both components were 2.85°±4.07°in control group and 0.28°±3.43°in navigation assisted group,mismatch between components were 1.44°±4.55°in conlrol group and-0.43°±2.86°in navigation assisted group.There were no significant differences between two groups in rotation of tibial component.In addition,analysis showed that patients in navigation assisted group had significantly better mechanical axes and functional outcomes at 6 weeks.Conclusion The use of navigation can help avoid malrotation and errors in axial rotation,and provides improved alignment accuracy as well as better functional outcomes at 6 weeks.

Objective To observe and analyse the application effect and value of problem based learning (PBL) combined evidence-based learning (EBL) in emergency medicine clinical teaching.Methods A total of 53 clinical medicine students were selected.The combined teaching method was applied in emergency clinical teaching.After the end of the teaching,the teaching effectiveness survey and theory test of the combined teaching group was performed,and the theory test scores was compared with the traditional teaching group.Results The combined teaching method could stimulate learning enthusiasm,improve learning efficiency,the abilities of selfstudy,literature retrieval,and the ability to analyze and solve problems.77.4％ of students thought this new teaching method had good application value in clinical teaching.Furthermore,the excellent rate of the theory test scores combined teaching group was better than traditional teaching group (41.5％ vs 15.6％,x2 =7.868,P =0.007).Conclusions The PBL joint EBL pedagogy can overcome diadvantages of tradional teaching and provide higher interest,ability of self-study as well as higher teaching quality of the medical students.It will be worth to spread in medical clinical teaching.

Objective To systematically review the efficacy of hypotensive resuscitation for traumatic-hemorrhagic shock.Methods Randomized controlled trails (RCTs) or quasi-Randomized controlled trails (qRCTs) were searched in Pubmed,Embase and the Corchrane Library from inception to August 2015.Two reviewers respectively picked out the useful data and performed quality evaluation.Metaanalysis was carried out with RevMan 5.3 software,risk ratio (RR) and its 95％ confidence interval (CI) were pooled to estimate the enumeration data,and GRADE 3.6.1 software was used to rate the level of evidence.Results The results of meta-analysis and GRADE rating system which included 4 studies showed that:compared with conventional resuscitation,hypotensive resuscitation was associated with lower total mortality [RR =0.77,95％ CI:0.62-0.95,P =0.01;n =984,GRADE rating:moderate],and 24-hour mortality [RR =0.47,95％ CI:0.24-0.91,P =0.03;n =281,GRADE rating:moderate],but the subgroup analysis of total mortality showed that there were no significant differences in mortality between the subgroup of blunt or penetrating trauma and the subgroup of penetrating trauma.Conclusions Hypotensive resuscitation reduced total mortality and 24-hour mortality,and the quality of the evidence was moderate.The future studies should do further research to explore the efficacy of hypotensive resuscitation for different types of trauma.

Tumor occurrence and development is a complicated process.Previous studies confirm that DNA mutations result in activation of downstream pathways of tumor cells.Recently,studies of post-translational modifications showed that RNA editing play an important role in transcriptional mechanism.Thus,RNA editing further enrich the diversity of RNA and protein,participate in the process of many diseases,including cancer.Recently,many studies have focused on the RNA editing enzymne ADAR1 because of the complexity role in tumorigenesis and progression.This article mainly reviewed the role of ADAR1 in the occurrence and development of tumors.

Objeetive To investigate the effect of TURP on the quality of life of elderly PCa patients with LUTS symptoms.Methods A retrospective analysis of the clinical data from January 2012 to January 2014 of 75 patients admitted to our hospital after prostate puncture biopsy and pathological diagnosis of PCa in elderly patients,mean age (79 ± 7) years old,which 44 cases were associated with different degrees of LUTS symptoms,of which,20 underwent TURP.After the rule of endocrine therapy,we observe and record of patients before and after treatment and 3,12,6 months after the IPSS and QOL score,compared with the changes in the quality of life of patients.Results Forty-four cases of patients with IPSS score in treatment group after 3,6 and December were (6.25 ± 2.53),(5.15 ± 2.25),(5.00 ± 2.36).Compared with the preoperative IPSS basal value (30.55 ± 3.62),the difference was statistically significant (P ＜0.01).However,there was no significant difference in the postoperative patients (P =0.209,0.863,0.154).The QOL score of treatment group after 3,6 and 12 months were (1.35 ± 1.14),(0.85 ± 0.75) and (0.70 ± 0.87).Compared with the preoperative QOL basal value (4.70 ± 0.73),the difference was statistically significant (P ＜ 0.01).However,there was also no significant difference in the postoperative patients (P =0.078,0.023,0.593).Compared with the control group of IPSS and QOL score,there was no significant difference before treatment in the treatment group (F =0.105,P =0.747),however,there was significant difference after treatment(P ＜ 0.01).Conclusions TURP is a safe and effective method to improve the quality of life and improve the quality of life of patients with prostate cancer.

Colorectal cancer is currently the third most common cancer worldwide,and there are still half of the patients undergoing recurrence and metastasis after surgical treatment,so it is necessary for colorectal cancer patients to receive radiation therapy routinely.Due to the side effects brought by radiotherapy,it is of great importance to solve how to minimize the radiation dose in radiation therapy and improve radiation sensitivity.In recent years,people discovered that microRNAs can not only be involved in the origins of colorectal cancer and progress,but also play a increasingly important role in cancer radiosensitivity.MicroRNAs can regulate tumor radiosensitivity by influencing tumor microenvironment and function on target genes.DNA damage response caused by radiation includes the activation of ATM,histone modification and chromatin remodeling,cell cycle arrest,damage repair and apoptosis.microRNAs can regulate tumor radiosensitivity through above processes.This review focuses on the mechanism of microRNAs in affecting DNA damage repair and prospects the future of microRNAs in influencing the sensitivity of cancer radiotherapy in clinical application.

Traumatic coagulopathy is a serious complication of tissue damage caused by trauma.In clinic,it easily develops into multiple system organ failure and results in high mortality.Traumatic coagulopathy is a plurality of blood coagulation disorder,its pathogenesis is extremely complex and involves tissue damage,blood coagulation,anticoagulation and fibrinolysis,inflammation and many other pathophysiological aspects.An in-depth study on the pathogenesis of traumatic coagulopathy is very important to improve clinical effect.This paper tries to do a review of recent study progress from pathophysiological mechanisms and hopes to provide reference for clinical work.

BACKGROUND:Although there is a certain progress in the preparation of tissue-engineered bone tissue using a variety of materials, some deficiencies have appeared such as mismatching between scaffold degradation rate and new bone formation rate, slow tissue growth, toxic metabolites.
OBJECTIVE:To build a new type of inducible bone repair composite scaffold with bionic bone structurematerials and to evaluate its physicochemical and biological properties.
METHODS: Icarin encapsulated by chitosan was used to prepare drug-loaded microspheres, and the drug release rate of the microspheres was detected. Chitosan microspheres were mixed with colagen to build the core part of scaffold materials. Hydroxyapatite (HA), polycaprolactone (PCL) and colagen were mixed in hexafluoride isopropanol (HFIP) to prepare the HA/PCL/colagen outer part of composite scaffold material at the rate of 0:3:3, 1:3:3, 2:3:3, 3:3:3. Each proportional electrospinning was used for one layer, and finaly the 4-layer outer tube of the scaffold was produced. The tube core and outer tube were crosslinked by 1% genipin. Universal material testing machine, surface contact angle meter, infrared spectroscopy, scanning electron microscope, water absorption, permeability, porosity,in vitro degradation tests for cross-linked and uncross-linked were used to observe the structure and characteristics of tubular materials. Bone marrow mesenchymal stem cels were seeded on the surface of cross-linked and uncross-linked bone repair materials to evaluate the biocompatibility of the scaffolds. Cross-linked and uncross-linked bone repair materials were implanted subcutaneously into Wistar rats to evaluate the histocompatibility of the scaffolds.
RESULTS AND CONCLUSION:The drug in the scaffold had a suitable release; the bone scaffold material had good uniformity, and cross-linked scaffolds materials had better mechanical properties, water absorption and permeability than the uncross-linked(P < 0.05). The degradation rate of the cross-linked group was significantly lower than that of the uncross-linked group (P< 0.05). Hematoxylin-eosin staining showed that the bone marrow mesenchymal stem cels could adhere wel to the cross-linked and uncross-linked materials. No inflammatory reactions occurred after subcutaneous implantation of cross-linked and uncross-linked materials. These findings indicate that the cross-linked scaffold for inducible bone tissue engineering has good biocompatibility and mechanical properties.

Objective To evaluate the treatment of current status and prognosis in childhood APL with APL2008 ,which was administrated since 2008 in our center .Methods A total of 43 children with newly diagnosed APL between 2008 to 2014 were studied retrospectively .Treatment options and current status were summarized from 28 patients who received APL2008 therapy . Results Studied 43 patients were at median age of 8 years and 4 months ,with 28 boys and 15 girls .The main clinical manifestations were infection ,anemia ,bleeding ,fever ,hepatomegaly ,splenomegaly and lymphadenopathy .The proportions of low ,intermediate and high risk groups were 27 .9% ,48 .8% and 23 .3% ,respectively .Eleven cases could be diagnosed as DIC .Bone marrow morphology showed abnormal elevation of promyelocyte .37 patients had distinctive immunophenotype such as frequent expression of CD33 , CD117 and MPO .PML/RARαfusion gene positive rate was 100% in 43 children and cytogenetic analysis were positive in 37 cases , of which specific genetic lesion in APL cells with t (15 ;17)(q22 ;q12) was found in 28 cases ,and karyotypes was found in 9 cases as infrequent chromosomal abnormalities .In 43 patients ,4 cases were early dead from intracranial hemorrhage at early stage ,and 11 cases were given up early .There were only 2 cases dead ,2 cases relapsed and 1 case lost among 28 APL children ,which enabled ef‐ficacy analysis possible .96 .4% of these 28 cases achieved HCR .The 2 year Kaplan Meier estimates of OS and EFS were 85 .9% ± 7 .6% and 80 .4% ± 8 .8% .But OS and EFS would be 94 .7% ± 5 .1% and 88 .9% ± 7 .4% if 3 patients who had non standard treat‐ment were excluded .Conclusion Childhood APL were characterized by anemia ,bleeding ,fever and infiltration .APL′s coincidence rate between PML/RARa fusion gene and morphology ,immunology and cytogenetics were 95 .3% ,90 .2% and 86 .5% ,respective‐ly .APL2008 significantly improved the prognosis of APL .

Objective Gambogic acid ( GA) can suppress the growth of multiple tumor cells , including gastric carcinoma , hepatoma , hematologic neoplasms and breast carcinoma , but there have been few reports about its effect on urologic neoplasms .This study was to investigate the possible mechanisms of GA inducing bladder cancer cell apoptosis and cell cycle arrest . Methods We cultured human bladder cancer BIU8-7 cell lines in vitor and treated the cells in the logarithmic growth phase with isotonic saline solu-tion (negative control)or GA at the concentrations of 1.0, 2.0, and 3.0μmol/L, respectively.We determined the expression of the Caspase-3 protein in the tumor tissue using the immunohistochemical S-P method and detected GA-induced apoptosis of the bladder cancer cells and cell cycle changes by flow cytometry . Results The expressions of the Caspase-3 protein were 4.28 ±1.86, 5.03 ± 0.78, and 6.47 ±1.31 in the 1.0, 2.0, and 3.0μmol/L GA groups, respectively, significantly higher than 2.13 ±1.27 in the nega-tive control (P<0.05).Flow cytometry showed a gradual decrease of the cells in the G 0/G1 phase and a gradual increase in the G2/M phase , but no obvious change in the S phase . Conclusion Gambogic acid can promote the apoptosis , arrest the cell cycle , and in-hibit the proliferation of bladder cancer cells by increasing the expression of the Caspase -3 protein.